TB test guidelines based on US standards, but system has gaps
To protect patients and staff, hospitals typically test their workers for tuberculosis before they are hired and annually afterward. But the system, based on guidelines from the federal government, has gaps.
Sometimes employees miss their scheduled testing, according to Dr. Michael Charness, chief of staff for the VA Boston Healthcare System. And many hospitals test only their permanent employees, relying on others to check healthcare workers who come to the hospital periodically.
Charness said the VA is planning to tighten its yearly testing requirements.
However, he said there are no plans to begin testing doctors who rotate in from other facilities, such as the surgical intern who worked at the VA's West Roxbury hospital in May while infected with TB. VA Boston officials believe that Boston Medical Center, where the woman was based, was responsible for testing her, Charness said. Yet guidelines issued by the Centers for Disease Control and Prevention state that hospital administrators should check on any medical workers in their facility, even for brief periods.
The CDC guidelines, which hospitals are not legally required to follow, suggest that hospitals that see many patients with TB test as frequently as four times a year. But the VA typically handles only a case or two a year and had not had an employee with TB in at least five years, Charness said.
At Boston Medical Center, Brockton Hospital, and Cape Cod Hospital, where the infected intern also worked recently, all healthcare workers are tested annually for tuberculosis and, in some cases, more frequently. Specialists at Brockton Hospital thought to be at higher risk of exposure, including surgeons and emergency room doctors and nurses, are routinely tested more than once a year, hospital spokesman Rich Copp said.
If a worker gets a positive result on the annual skin test for TB, most hospitals require them to get a chest X-ray and a complete exam to determine whether they have the active and contagious form of the disease. The exam looks for such symptoms as persistent cough, fever, bloody sputum, or night sweats. The CDC recommends that a worker be off work until additional tests show they are not contagious or until they are treated for the illness.
''If there's any question whatsoever on the X-ray, they're removed from work, regardless of what area of the hospital they work in," Copp said. ''And they can't come back until they get the green light from our in-house TB specialists."
If the X-ray is negative, the CDC guidelines say there is no need for additional X-rays unless symptoms develop. The CDC is reviewing all TB guidelines, because they are a decade old.
Dr. Eric Rubin, a specialist in infectious diseases at Harvard School of Public Health and Brigham and Women's Hospital, said that the screening system isn't perfect, but he doesn't believe the rules need to be stricter.
''People can get infected and sick before a year has passed, but the mechanisms in place work most of the time," he said. ''TB is really rare here."
Stephen Smith of the Globe staff contributed to this report. 